Vestibular neuronitis

Question 1

What?

Answer 1

Disorder characterized by acute, isolated, spontaneous, and prolonged vertigo of peripheral origin.
Inflammation of vestibular nerve

Question 2

When may this occur?

Answer 2

After viral infection

Question 3

Is hearing affected?

Answer 3

No

Question 4

Who?

Answer 4

Men = women
30- 60
Spring and summer months

Question 5

Symptoms?

Answer 5

Rotational vertigo occurs spontaneously 
Develop in waking or may worsen over course of day 
Nausea and vomiting
Malaise, pallor, sweating 
Balance may be affected
No hearing loss or tinnitus

Question 6

What may exacerbate vertigo?

Answer 6

Changes of head position - initially constant when head is still

Question 7

Signs?

Answer 7

Nystagmus

Question 8

Describe the nystagmus associated with this?

Answer 8

Fine horizontal
May be fixed horizontal- torsional with fast phase away from affected ear
Unidirectional

Question 9

Diagnosis?

Answer 9

Clinical diagnosis
Any recent illness (e.g. URT)?
Head impulse test may be positive
Hearing and otoscopy normal

Question 10

What is the head impulse test?

Answer 10

Rapid repositioning of head

Question 11

Advice and reassurance?

Answer 11

Symptoms usually settle over several weeks
Alcohol, tiredness, intercurrent illness may have greater effect on balance
Symptoms may worsen
Bed rest may be nec in acute phase
Don’t drive when dizzy
Inform workplace

Question 12

Symptoms treatment for relief of severe nausea, vomiting and vertigo?

Answer 12

Buccal prochlorperazine or IM injection of prochlorperazine or cyclizine

Question 13

Treatment to alleviate less severe nausea, vomiting, vertigo

Answer 13

Short oral course of prochlorperazine or antihistamine (cinnarizine, cyclizine, promethazine teoclate)